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Safety of intra-arterial treatment in acute ischaemic stroke patients on oral anticoagulants. A cohort study and systematic review
- Source :
- European Journal of Neurology, 23(2), 290-296, European Journal of Neurology, 23(2), 290. Wiley-Blackwell, European Journal of Neurology, 23(2), 290-296. Wiley-Blackwell Publishing Ltd
- Publication Year :
- 2016
-
Abstract
- Background and purpose: An elevated international normalized ratio (INR) of >1.7 is a contraindication for the use of intravenous thrombolytics in acute ischaemic stroke. Local intra-arterial therapy (IAT) is considered a safe alternative. The safety and outcome of IAT were investigated in patients with acute ischaemic stroke using oral anticoagulants (OACs). Methods: Data were obtained from a large national Dutch database on IAT in acute stroke patients. Patients were categorized according to the INR: >1.7 and ≤1.7. Primary outcome was symptomatic intracerebral hemorrhage (sICH), defined as deterioration in the National Institutes of Health Stroke Scale score of ≥4 and ICH on brain imaging. Secondary outcomes were clinical outcome at discharge and 3 months. Occurrence of outcomes was compared with risk ratios and corresponding 95% confidence intervals. Further, a systematic review and meta-analysis on sICH risk in acute stroke patients on OACs treated with IAT was performed. Results: Four hundred and fifty-six patients were included. Eighteen patients had an INR > 1.7 with a median INR of 2.4 (range 1.8-4.1). One patient (6%) in the INR > 1.7 group developed a sICH compared with 53 patients (12%) in the INR ≤ 1.7 group (risk ratio 0.49, 95% confidence interval 0.07-3.13). Clinical outcomes did not differ between the two groups. Our meta-analysis showed a first week sICH risk of 8.1% (95% confidence interval 3.9%-17.1%) in stroke patients with elevated INR treated with IAT. Conclusion: The use of OACs, leading to an INR > 1.7, did not seem to increase the risk of an sICH in patients with an acute stroke treated with IAT.
- Subjects :
- Adult
Male
medicine.medical_specialty
Neurology
Adolescent
Clinical Neurology
Review
030204 cardiovascular system & hematology
Brain Ischemia
Cohort Studies
Young Adult
03 medical and health sciences
0302 clinical medicine
Internal medicine
Outcome Assessment, Health Care
Journal Article
Humans
Infusions, Intra-Arterial
Medicine
cardiovascular diseases
Child
Stroke
Contraindication
Intra-arterial treatment
Aged
Thrombectomy
Aged, 80 and over
Intracerebral hemorrhage
Internationalized normalized ratio
business.industry
Anticoagulants
Middle Aged
medicine.disease
United States
Confidence interval
Oral anticoagulants
Surgery
Meta-analysis
Relative risk
Female
Neurology (clinical)
business
030217 neurology & neurosurgery
Cohort study
Subjects
Details
- Language :
- English
- ISSN :
- 13515101
- Volume :
- 23
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- European Journal of Neurology
- Accession number :
- edsair.doi.dedup.....069b784531c630ca6dba6d568743ef00